2012 Medicare Advantage Plan Information Click here to jump to the Chart Legend & Search Tips | |||||||||||
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Plan Name | County | Monthly Prem. (Parts C & D) |
Deduct- ible |
(Donut Hole) Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance 30-Day Supply |
MOOP for Part A & B Benefits | |||||
Cust. Service Rating |
Member Plan Exper. |
RxCost Info Rating |
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Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Clackamas | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Columbia | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Lane | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Marion | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Multnomah | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Polk | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Washington | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) in OR - H9047-001-0 Benefit Details |
Yamhill | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Providence Medicare Extra + RX (HMO) in WA - H9047-001-0 Benefit Details |
Clark | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
Plan Name | County | Monthly Prem. |
Deduct- ible |
Additional Gap Coverage |
Preferred Pharmacy Copay/ Coinsurance |
MOOP for A & B |
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Service | Exper. | Cost Info | |||||||||
Providence Medicare Extra + RX (HMO) in WA - H9047-001-0 Benefit Details |
Snohomish | $130.00 | $0 | No additional gap coverage, only the Donut Hole Discount | Tier 1: $7.00 Tier 2: $50.00 Tier 3: 33% | $2,500 Browse Formulary | |||||
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